For the last 25 years as a government official, 63-year-old Shyam Sharma (name changed) has often been returning home from work early disregarding crucial meetings scheduled for the day. A sudden rush of fatigue and headache made it impossible for him to concentrate. He never divulged to his colleagues that he was suffering from depression, and that he was under medication. Even during times when he asked for a leave of absence, he feigned physical discomfort. Having resigned from his position two years short of his official retirement, Sharma is currently attending psychotherapy sessions at a counselling centre in Kathmandu.

Shining a light

In health terminology, Sharma’s inability to work due to his depression is described as disability due to disease. An article in the medical journal The Lancet says mental illnesses account for the largest loss of 32.4 percent of productive years due to disability. The cost of Sharma’s depression-induced disability is huge in terms of his lost productivity, work satisfaction and overall happiness. The World Health Organisation (WHO) says depression and anxiety cost the world $1 trillion each year in lost productivity.

The problem is that the cause of these losses is not visible as physical disabilities. The theme of this year’s World Mental Health Day, which falls on October 10, is ‘Mental health in the workplace’ and is an initiative to make this invisible problem visible. A 2013 study showed about 37.5 percent of Nepalis have mental disorders. Nepal fulfils core risk factors—disasters, poverty and conflict—that the WHO has identified as making nations more vulnerable to mental health incidences. Assessing mental health challenges at the workplace and tackling them can be effective ways to create awareness and end the stigma. Lack of studies focusing on mental health at the workplace makes it hard to pinpoint specific challenges. Individual experiences like Sharma’s help offer critical insights. 

There is no reason to doubt that stigma is the greatest challenge as it deters individuals like Sharma from divulging their problems to colleagues for fear of being ridiculed. But keeping mum invites other problems. Sharma’s absences, and abrupt mood swings at work, reduced his performance and soured relations with colleagues. For many others, like school teacher Praveen Phyual (name changed) from Janakpur, the consequences were much harsher. A patient of schizophrenia, his occasional absences from work cost him his job.

Safeguarding workers

Lack of laws on which those suffering from such disabilities can fall back upon speaks volumes about missing protection. On the contrary, work-related provisions in the government and private sectors discriminate against those suffering from mental illness. They state that a person should be mentally fit to work, but fall short of explaining what mental fitness means, leaving room for varied interpretations to the employer. Our workplaces are rigidly hierarchical in structure, with employees having unequal power to decide work affairs, even those that directly affect them. This makes it hard for employees, especially those at the bottom of the hierarchy, to share their problems and issues impacting their work satisfaction, grievances and productivity. 

There is strong evidence to confirm that employees in Nepal have many concerns and issues. A comprehensive research entitled Guarding Minds at Work by Simon Fraser University, Canada determined 13 psychosocial factors as having powerful impact on employees’ health. Among them are workload management, balance, psychological support, appropriate reward and motivations, which are not very different from factors identified by the WHO and other concerned organisations as being vital for mental wellbeing at work. Nepal scores low on these factors. Private sector employers are known to pay less than the minimum wage fixed by the government. This applies not only to low skilled workers like brick kiln workers but also skilled workers like teachers, journalists and nurses.

A government study conducted earlier this year found that nurses were overworked and paid as little as Rs3,000 per month. Separate surveys done by the BP Koirala Institute of Health Sciences and Dhulikhel Hospital have found that nurses were exhibiting signs of depression owing to, among other reasons, work overload and low pay. Poor working conditions are the chief obstacle to the mental wellbeing of migrant workers. With 1,500 youths leaving daily to work in the Gulf and Malaysia, Nepal’s efforts to create healthy workplaces would be incomplete without addressing their needs. Experts and studies attribute a significant portion of migrant worker deaths to excessive workload and stress leading to Sudden Unexpected Death Syndrome (SUDS) during sleep. 

Government and policymakers should understand that pushing back issues of mental health is inflicting losses to the economy. It is the government’s responsibility to draft clear laws to safeguard the rights of employees with mental health problems and ensure their implementation. It should constantly monitor implementation of work-related legislation to ensure employer compliance with regard to pay, working hours and other provisions. Of particular urgency is its duty to forge deals with destination countries to ensure a healthy environment for migrant workers.

Individual workplaces have the biggest responsibility to ensure the sound mental health of employees. Business houses, international organisations and media houses in Kathmandu that have the most access to resources, information and knowledge should take the lead. Media houses can set an example by promoting mental health talks in the workplace and organising campaigns to highlight the issue. Our workplaces will promote mental wellbeing only when employers, above all, internalise the idea that a mental health-friendly environment ensures the good health of employees, and enhances their productivity and ultimately benefits their organisations.

- Gautam writes on contemporary social and cultural issues; Khatiwada holds a Master’s in psychology from Tribhuvan University